Lake Placid Biathlon Club
Membership Application
Membership Year Oct 1st-Sept 30
This is not an on-line registration form. Please print out the form and send it to the LPBC via regular mail.
Name:_________________________________________ DOB:___________________
Address:______________________________________________________________
______________________________________________________________________
Phone No.(s)________________________ Email:__________________________
Male or Female (circle one)
USBA#:________________________ NYSSRA #:____________________
Application Fee
Individual: $5.00
Family: $10.00 Please list all names and info on form or attach a separate sheet
Volunteers and Officials : FREE
Send checks to Lake Placid Biathlon Club
C/O Rick Costanza 61 Mt Pisgah Lane, Saranac Lake, NY 12983
Contacts
President: Tracy Lamb 518-523-2600, tracy.lamb@usoc.org
Vice President: Rick Costanza 518-891-6538, rtcostanza@adelphia.com